Introduction

Justinus Kerner, a German medical doctor and poet, was the first to describe botulism in detail. He recognized the disease to be related to the consumption of poison in sausages, and described how these were improperly prepared. His description of the disease (Kerner1822), including the paralysis of muscles and reduction of glandular function, was as accurate and complete as any today. He extracted the toxin, applied it in animals and considered the therapeutic value of the extracted poison, especially in motor overexcitability (for instance in chorea minor). However, it took around 150 years until botulinum toxin (BoNT) was first used for therapeutic measures. This was done by a coauthor of this chapter, who examined a number of chemical substances in order to find one which could lengthen an extrinsic eye muscle in order to have an alternative to squint operation. In animal tests BoNT proved to be the only substance that showed the desired paralytic effect and was locally and systemically well tolerated in a very low dose (Scott et al., 1973). The first patients were treated in 1978 (Scott, 1980). Meanwhile, it is evident that this method is safe but cannot replace surgery for most strabismus cases, because the long-term effect is not stable in many patients (Figure 10.1).

Besides strabismus – as you see in this book – BoNT has emerged as an important or even first-line treatment for many medical disorders as well as for cosmetic indications.